Why is the world's largest organization of psychologists so
aggressively promoting a new, massive, and untested military program?
The APA's enthusiasm for mandatory "resilience training" for all U.S.
soldiers is troubling on many counts.

The January 2011 issue of the American Psychologist, the
American Psychological Association's (APA) flagship journal, is devoted
entirely to 13 articles that detail and celebrate the virtues of a new
U.S. Army-APA collaboration. Built around positive psychology and with
key contributions from former APA president Martin Seligman and his
colleagues, Comprehensive Soldier Fitness (CSF) is a $125 million
resilience training initiative designed to reduce and prevent the
adverse psychological consequences of combat for our soldiers and
veterans. While these are undoubtedly worthy aspirations, the special
issue is nevertheless troubling in several important respects: the
authors of the articles, all of whom are involved in the CSF
program, offer very little discussion of conceptual and ethical
considerations; the special issue does not provide a forum for any
independent critical or cautionary voices whatsoever; and through this
format, the APA itself has adopted a jingoistic cheerleading stance
toward a research project about which many crucial questions should be
posed. We discuss these and related concerns below.

At the outset, we want to be clear that we are not questioning
the valuable role that talented and dedicated psychologists play in the
military, nor certainly the importance of providing our soldiers and
veterans with the best care possible. As long as our country has a
military, our soldiers should be prepared to face the hazards and
horrors they may experience. Military service is highly stressful, and
psychological challenges and difficulties understandably arise
frequently. These issues are created or exacerbated by a wide range of
features characteristic of military life, such as separation from
family, frequent relocations, and especially deployment to combat zones
with ongoing threats of injury and death and exposure to acts of
unspeakable violence. The stress of repeated tours of duty, including
witnessing the loss of lives of comrades and civilians, can produce
extensive emotional and behavioral consequences that persist long after
soldiers return home. They include heightened risk of suicide,
posttraumatic stress disorder (PTSD), substance abuse, and family
violence.

Conceptual and Empirical Concerns

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Although its advocates prefer to describe Comprehensive Soldier Fitness as a training program, it is indisputably a research project of enormous size and scope, one in which a million soldiers are required to participate. Reivich, Seligman, and McBride write in one of the special issue articles, "We hypothesize
that these skills will enhance soldiers' ability to handle adversity,
prevent depression and anxiety, prevent PTSD, and enhance overall
well-being and performance" (p. 26, emphasis added). This is the very
core of the entire CSF program, yet it is merely a hypothesis -- a
tentative explanation or prediction that can only be confirmed through
further research.

There seems to be reluctance and inconsistency among the CSF
promoters in acknowledging that CSF is "research" and therefore should
entail certain protections routinely granted to those who participate in
research studies. Seligman explained to the APA's Monitor on Psychology,
"This is the largest study -- 1.1 million soldiers -- psychology has ever
been involved in" (a "study" is a common synonym for "research
project"). Butwhen asked during an NPR interview
whether CSF would be "the largest-ever experiment," Brig. Gen. Cornum,
who oversees the program, responded, "Well, we're not describing it as
an experiment. We're describing it as training." Despite the fact that
CSF is incontrovertibly a research study, standard and important
questions about experimental interventions like CSF are neither asked
nor answered in the special issue. This neglect is all the more
troubling given that the program is so massive and expensive, and the
stakes are so high.

It is highly unusual for the effectiveness of such a huge and
consequential intervention program not to be convincingly demonstrated first
in carefully conducted randomized controlled trials -- before being
rolled out under less controlled conditions. Such preliminary studies
are far from a mere formality. The literature on prevention
interventions is full of well-intentioned efforts that either failed to
have positive effects or, even worse, had harmful consequences for those
receiving them. For instance, in the 1990s the DARE (Drug Abuse
Resistance Education) substance abuse prevention program was
administered in thousands of elementary schools across the U.S., at a
cost of many hundreds of millions of dollars. Yet evaluations of DARE
rarely found the desired effects in regard to reducing young people's
later substance use (e.g., see this and this summary). In response, DARE was modified in the last decade; however, subsequent evaluation found that the revised program actually increased later alcohol and cigarette use in those who received it compared to controls.

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Similarly, criminal justice researcher Joan McCord has demonstrated how well-meaning programs have caused actual harm.
She conducted a 30-year follow-up of a classic delinquency prevention
program. Those participants randomly selected for intervention, but not
matched controls, were provided with extensive enrichment, including
mentoring, counseling, and summer camp. Among the matched pairs who
differed in outcomes decades later, those who received the intensive
assistance were more likely to have been convicted of serious street crimes; were more frequently
given a diagnosis of alcoholism, schizophrenia, or manic depression;
and on average died five years younger. Other studies of criminal
justice interventions have also uncovered unanticipated, deleterious
effects. Given this well known record, it is especially concerning when a
major intervention is rolled out for thousands -- or hundreds of
thousands -- without careful prior examination, including an
investigation of potential negative effects. The special issue of the American Psychologist gives no indication that preliminary studies of CSF were conducted.

Also problematic, the CSF program is adapted primarily from the Penn
Resiliency Program (PRP) where interventions were focused on
dramatically different, non-military populations. Even with these
groups, a 2009 meta-analysis of 17 controlled studies reveals that the
PRP program has been only modestly and inconsistently effective. PRP
produced small reductions in mild self-reported depressive symptoms, but
it did so only in children already identified as at high risk for
depression and not for those from the general population. Nor did PRP
interventions reduce symptoms more than comparison prevention programs
based on other principles, raising questions as to whether PRP's effects
are related to the "resilience" theory undergirding the program.
Further, like many experimental programs, PRP had better outcomes when
administered by highly trained research staff than when given by staff
recruited from the community. This raises doubts as to how effectively
the CSF program will be administered by non-commissioned officers who
are required to serve as "Master Resilience Trainers."

Regardless of how one evaluates prior PRP research, PRP's effects
when targeting middle-school students, college students, and adult
groups can hardly be considered generalizable to the challenges and
experiences that routinely face our soldiers in combat, including those
that regularly trigger PTSD. In an inadequate attempt to bridge this gap
rhetorically, CSF proponents describe PTSD as "a nasty combination of
depressive and anxiety symptoms" (Reivich, Seligman, & McBride, p.
26). In fact, PTSD
involves a far more complicated cluster of severe symptoms in response
to a specific traumatic event, including flashbacks, partial amnesia,
difficulty sleeping, personality changes, outbursts of anger,
hypervigilance, avoidance, and emotional numbing.

Ethical Concerns

We also believe that other key aspects of Comprehensive Soldier
Fitness should have received explicit discussion in this special issue.
It is standard practice for an independent and unbiased ethics review
committee (an "institutional review board" or "IRB") to evaluate the
ethical issues arising from a research project prior to its
implementation. This review and approval process may in fact have
occurred for CSF, but the manner in which the principals blur "research"
and "training" leads us to wish for much greater clarity here. This
process is even more critical given that the soldiers apparently have no
informed consent protections -- they are all required to participate in the CSF program. Such research violates the Nuremberg Code developed during the post-World War II trials of Nazi doctors. That code begins by stating:

The voluntary consent of the human subject is absolutely essential.

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This means that the person involved should have legal capacity to give
consent; should be so situated as to be able to exercise free power of
choice, without the intervention of any element of force, fraud, deceit,
duress, over-reaching, or other ulterior form of constraint or
coercion; and should have sufficient knowledge and comprehension of the
elements of the subject matter involved as to enable him to make an
understanding and enlightened decision.

Disturbingly, however, this mandatory participation in a research study does not violate Section 8.05
of the APA's own Ethics Code, which allows for the suspension of
informed consent "where otherwise permitted by law or federal or
institutional regulations." Despite the APA's stance, we should never
forget that the velvet glove of authoritarian planning, no matter how
well intended, is no substitute for the protected freedoms of
individuals to make their own choices, mistakes, and dissenting
judgments. Respect for informed consent is more, not less, important in
total environments like the military where individual dissent is often
severely discouraged and often punished.

More broadly, the 13 articles fail to explore potential ethical
concerns related to the uncertain effects of the CSF training itself. In
fact, the only question of this sort raised in the special
issue -- by Tedeschi and McNally in one article and by Lester, McBride,
Bliese, and Adler in another -- is whether it might be unethical to withhold the
CSF training from soldiers. Certainly, there are other ethical
quandaries that require serious discussion if the CSF program's
effectiveness is to be appropriately evaluated. For example, might the
training actually cause harm? Might soldiers who have been trained to
resiliently view combat as a growth opportunity be more likely to ignore
or under-estimate real dangers, thereby placing themselves, their
comrades, or civilians at heightened risk of harm?